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Revenue cycle directors deal with a competitive market for staff as elective care returns

June 11, 2021 at 11:00:00 PM

Because of COVID-19's push to a remote workforce, hospitals are competing for billers and coders not just locally, but nationally.



Revenue cycle directors deal with a competitive market for staff as elective care returns


Susan Morse

COVID-19 created a new remote administrative workforce. Now, nearing the end of the pandemic, bringing staff back in-house may not be ideal, especially during a competitive environment for coding and billing talent.

All but those on the front end of the revenue cycle registering patients at Mercyhealth were able to work from home during COVID-19, as did administrative staff at many hospitals nationwide. Some revenue cycle functions were already being done from home.

The pandemic didn't initiate the virtual workforce "but it accelerated our acceptance of it," said Kimberly Scaccia, vice president of Revenue Management for Mercyhealth in Wisconsin and Illinois.

Now Scaccia, as are many other managers, is considering a hybrid work situation rather than bringing everyone back in.

Some staff want to stay remote while others tell her, "'Please don't send me home again,'" she said. "We have both spectrums. Also, there are those folks who like the flexibility."

Scaccia wants to meet the needs of employees who, without being frontline hospital workers, have also experienced burnout due to COVID-19.

"This is something I am passionate about," Scaccia said. "I truly believe the burnout, the weariness of the staff, the only way to combat it is to be a good leader. That weariness is not just the job. It's home. We've gone from having to deal with an office culture to a virtual culture with everybody's families and kids and appropriate space."


It's a fierce, competitive market for healthcare staff, not just for clinicians but in revenue cycle departments.

There is high demand for billers and coders now that elective surgeries and demand for care is coming back with a vengeance, according to Luke Thiem, senior vice president of Healthcare at Addison Group, which does recruitment and consulting.

"One of the trends I'm seeing right now, the market is very tight." Thiem said. "There's more competition, it's a super competitive landscape both for clinical and nonclinical. Even since February, I've seen the gap between job seekers and openings get wider and wider."

Thiem agrees that revenue cycle staff experienced burnout as many first faced furloughs or layoffs and then, all at once, were asked to come back to work, often doing work above their experience level because of staffing shortages. There are high expectations for being able to collect the money owed to balance the accounts receivable.

Because of COVID-19's virtual push, hospital executives are competing for staff not just against other hospitals in the region, but against health systems nationwide. Remote workers can work for any organization, anywhere.

"I'm competing with everywhere because everybody is remote," Scaccia said.

Salaries are coming up, especially in rural areas, which used to be able to pay lower rates because the cost of living in non-urban areas is lower, according to Thiem.

To retain staff, Thiem recommends that employers ask what their employees want. More than money, what he hears is a desire for flexibility, a better work-life balance.

In hiring, organizations should look outside of the perfect candidate profile and be willing to create a training program for inexperienced staff, he said.


Working remotely has brought new security issues, both in cybersecurity and in protecting patient's HIPAA rights.

Training remains an issue at Mercyhealth as onboarding still requires new employees to physically come onsite, according to Scaccia.

The right technology must be in place. Mercyhealth was already in the process of implementing workflow technology when the pandemic hit. Scaccia came aboard as head of revenue cycle on March 23, 2020.

"We had $368 million in receivables we had to collect," Scaccia said. "We had to figure out how to take the business side and send people home in a short period of time."

Basically, she said, workers were sent home with their desktop computers. They had IM for internal communications, but phone and fax capability for all of the paper still generated in the revenue cycle, needed to be figured out.

There was no guidebook for making the move to a remote workforce and everything had to be implemented virtually overnight.

"There's no manual," Scaccia said. "I found one white paper. The biggest complaint is, we weren't fast enough."

But the positive metrics from a remote workforce have substantiated the move.

Days in accounts receivable have decreased by 17 days, and cash earnings have increased to the point that the cash goal has been beat by over $20 million, she said.

When the lockdown began, Mercyhealth had 20 to 30 revenue cycle employees who started working from home for what was originally thought to be a short time. That number went up to 125. Currently, Scaccia is planning, long-term, for a hybrid situation for about 300 employees.

To do this there needs to be detailed tracking of remote staff productivity and effectiveness, with an ability to quickly identify and analyze high and low performers. Data informs which accounts should be worked, shifting metrics from measuring the volume of accounts to make productivity numbers to the effectiveness of the work.


An estimated 63% of adult Americans had been vaccinated as of June 2, according to figures released by the White House.

Hospitals in areas where the number of COVID-19 cases is falling are seeing a return to pre-pandemic levels of elective surgeries and medical care.

The Department of Veterans Affairs is seeing such an increase in demand for health services from veterans who either deferred care or couldn't get appointments during the pandemic that on June 8, VA Secretary Denis McDonough told the House Veterans Affairs Committee he needed more money, according to Funding is needed to add more than 19,000 new positions, including 17,000 healthcare jobs, to cover the growing cost of care both at department facilities and in the community, he said.

Staffing shortages, with a focus on the need for physicians and nurses, have been a growing concern for the entire healthcare sector nationwide even before the COVID-19 pandemic, with a looming forecast of a national deficit of the healthcare workforce by 2025, according to Health Affairs.

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